Annals for Educators - November 2022
Authors: Christine Laine
Journal: Annals of Internal Medicine (2022)

Web ExclusivesNovember 2022Annals for Educators - November 2022FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202211150 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsHeterogeneity in Obesity Prevalence Among Asian American AdultsUsing Body Mass Index to Identify and Address Obesity in Asian Americans: One Size Does Not Fit AllEvidence suggests that the risks posed by obesity occur at lower body mass index (BMI) thresholds in Asian populations than in White populations. This study estimated obesity prevalence among Asian Americans overall and among Asian ethnic subgroups in the United States, using standard and modified BMI thresholds to define obesity. The accompanying editorial discusses the findings and the need for obesity screening and treatment recommendations that consider patients' ethnicities.Use this article and the editorial to:Ask your learners to list the medical conditions associated with overweight and obesity.Review the BMI criteria that currently define overweight and obesity.Discuss the limitations of BMI as a measure of excess body weight.Besides BMI, are there other potentially useful indicators of unhealthy body size?Ask your learners to discuss the implications of the findings of this study given the ethnic backgrounds of the patients cared for in your health system.Characteristics of Persons Screened for Lung Cancer in the United States. A Cohort StudyLessons From Implementation of the U.S. Preventive Services Task Force Recommendations for Lung Cancer ScreeningThis article describes the first 1 million persons who had lung cancer screening and follow-up and were registered in the American College of Radiology's Lung Cancer Screening Registry and compares them with persons meeting the U.S. Preventive Services Task Force eligibility criteria and with participants in the National Lung Screening Trial. The accompanying editorial discusses the findings and the need to improve screening of the eligible population.Use this article and the editorial to:Review the indications for lung cancer screening.Review recommended screening interventions and recommendations for frequency of screening.Ask your learners whether they typically remember to screen eligible patients. If not, what are the barriers?Learn whether your health system has a special program for screening and, if so, invite a radiologist to review the procedure for screening with your learners.15-Year Benefits of Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality. A Pooled Analysis of Randomized TrialsColorectal cancer (CRC) is the third most common cancer worldwide. Flexible sigmoidoscopy is a recommended CRC screening modality. This study reports findings from a pooled analysis of available population-based randomized trial data on the effectiveness of screening flexible sigmoidoscopy in reducing CRC incidence and mortality.Use this article to:Review the current screening recommendations of the U.S. Preventive Services Task Force, the American Cancer Society, and the American Gastroenterological Association.Discuss the differences in the frequency of use of sigmoidoscopy as a screening modality in the United States compared with other countries. Is screening sigmoidoscopy used at your institution?Discuss the potential benefits and harms of screening sigmoidoscopy compared with screening colonoscopy and fecal tests.Discuss the findings of this study in the context of the findings of the 10-year results of a colonoscopy screening trial published in October 2022. The Impact of the COVID-19 Pandemic and Associated Control Measures on the Mental Health of the General Population. A Systematic Review and Dose–Response Meta-analysisThis systematic review uses novel methods to describe mental health symptoms during the first year of the COVID-19 pandemic and how they relate to the number of days since the start of the pandemic, the stringency of containment measures, and the cumulative numbers of cases and deaths.Use this article to:Initiate a discussion among your learners about whether the findings of this trial align with what they have observed among their patients, colleagues, and loved ones.Invite a behavioral health specialist to review strategies for helping patients who suffer from pandemic-related mental health symptoms.If your institution has a wellness coach, invite that person to discuss strategies that can help health care professionals cope with pandemic-related anxiety, depression, and burnout.Effectiveness of Opioid Analgesic Medicines Prescribed in or at Discharge From Emergency Departments for Musculoskeletal Pain. A Systematic Review and Meta-analysisPatients visiting the emergency department (ED) for musculoskeletal pain may differ from patients seen in the outpatient setting. This review compared the benefits and harms of opioids versus placebo or other nonopioid analgesics in the ED setting.Use this article to:Watch a brief video summarizing the results of this systematic review with your learners. Ask your learners about how frequently they see patients who were prescribed opioids during an ED visit for musculoskeletal pain.Review the American College of Physicians clinical guidelines for the management of low back pain and acute non–low back musculoskeletal pain. Preoperative Evaluation for Noncardiac SurgeryThe goal of preoperative assessment is to identify procedure and patient factors that affect the risk for postoperative complications. Preoperative risk stratification helps health care teams to fully understand a patient's operative morbidity. Careful, directed preoperative evaluation enables implementation of strategies to mitigate specific risks both preoperatively and postoperatively.Use this article to:Discuss why the appropriate term for evaluation of a patient before a surgical procedure is “preoperative evaluation” and not “preoperative clearance.”Ask your learners to list the different factors that need to be considered when evaluating a patient's risk for complications during noncardiac surgery.Review the risk assessment tools that are commonly used to evaluate a patient before surgery.What factors would contribute to a recommendation that a patient postpone a nonurgent surgical procedure?Review how to manage the administration of common antihypertensive, diabetes, and cardiac medications during the perioperative period.Test your learners' knowledge by having them complete the quiz that accompanies the article and then reviewing the correct answers.Systems-Based CareEnvironmental Health: A Position Paper From the American College of PhysiciansEnvironmental Health: Translating Policy Into ActionEnvironmental hazards are associated with poor outcomes for common diseases, including diabetes and heart disease. In this position paper, the American College of Physicians seeks to inform physicians about environmental health and offers policymakers recommendations to reduce the adverse health consequences of environmental hazards. The accompanying editorial discusses the recommendations and the critical need to ensure that they are effectively translated into action.Use this article and the editorial to:Ask your learners to create a list of health problems that are affected by climate change.Go online and review data on air quality in the region served by your health system. Ask your learners if the data they find are expected or surprising. Ask your learners whether routine awareness of these data could be helpful to patients.List ways that the health care system contributes to climate change and pollution.Brainstorm ways to decrease the negative effect of the health care industry on the environment.ProfessionalismDouble-BlindThis “On Being a Doctor” essay addresses the human side of asking our patients to participate in research studies.Use this article to:Ask your learners whether they have ever had to ask a patient to participate in a research study. If they have, what was the experience like?Invite someone who is on the institutional review board to join your session and describe the general policies at your institution for obtaining patient consent to participate in research.Have teams of learners role-play asking a patient to participate in a clinical trial of a new antiviral drug for COVID-19.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Christine Laine, MD, MPHFrom the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics November 2022Volume 175, Issue 11Page: ED11 ePublished: 15 November 2022 Issue Published: November 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...